Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
J Urol. 2012 Oct;188(4):1108-13. doi: 10.1016/j.juro.2012.06.018. Epub 2012 Aug 15.
We investigated induction carboplatin based chemotherapy in patients with nonorgan confined urothelial carcinoma who were considered unfit for cisplatin. A comparison was made with patients who received induction cisplatin based combination chemotherapy.
We identified 167 patients with nonorgan confined urothelial carcinoma who received induction cisplatin based combination chemotherapy (126) or gemcitabine and carboplatin (41) at our hospital between 1990 and 2010. Of the patients 124 completed 4 cycles of cisplatin based combination chemotherapy or gemcitabine and carboplatin. Clinical response (ycTNM) was evaluated according to RECIST (Response Evaluation Criteria in Solid Tumors) 1.1. Radical cystectomy and bilateral extended pelvic lymph node dissection were performed in 106 patients. A pathological complete response was defined as no evidence of disease (ypT0N0). Disease specific survival was analyzed using the Kaplan-Meier method. Multivariate analysis was performed.
Complete clinical response rates did not differ significantly among the treatment groups. A pathological complete response was seen in 33.7% of specimens in the cisplatin based combination chemotherapy group vs 30.3% in the gemcitabine and carboplatin group (p = 0.808). We found no significant difference in disease specific survival between patients who started cisplatin based combination chemotherapy and those who started gemcitabine and carboplatin. For patients who completed 4 cycles and underwent radical cystectomy there was also no significant difference in disease specific survival between the groups. On multivariate analysis a pathological complete response was the only variable significantly associated with disease specific survival (p <0.045).
Induction gemcitabine and carboplatin for nonorgan confined urothelial carcinoma achieves clinical and pathological response rates, and survival outcomes comparable to those of the cisplatin based combination chemotherapy schemes. Our data suggest that a carboplatin based regimen can be considered a reasonable alternative for cisplatin unfit patients in the preoperative setting.
我们研究了不适合顺铂治疗的非局部浸润性尿路上皮癌患者的卡铂诱导化疗。并将其与接受顺铂为基础的联合化疗的患者进行了比较。
我们在我院 1990 年至 2010 年间，共鉴定出 167 名接受顺铂为基础的联合化疗（126 例）或吉西他滨和卡铂（41 例）诱导化疗的非局部浸润性尿路上皮癌患者。其中 124 例患者完成了 4 个周期的顺铂为基础的联合化疗或吉西他滨和卡铂化疗。根据 RECIST（实体瘤反应评价标准）1.1 评估临床反应（ycTNM）。106 例患者行根治性膀胱切除术和双侧广泛盆腔淋巴结清扫术。无病证据定义为病理完全缓解（ypT0N0）。采用 Kaplan-Meier 法分析疾病特异性生存率。进行多变量分析。
各组之间完全临床缓解率无显著差异。顺铂为基础的联合化疗组病理完全缓解率为 33.7%，吉西他滨和卡铂组为 30.3%（p=0.808）。我们发现开始顺铂为基础的联合化疗和开始吉西他滨和卡铂的患者之间的疾病特异性生存率没有显著差异。对于完成 4 个周期并接受根治性膀胱切除术的患者，两组之间的疾病特异性生存率也无显著差异。多变量分析显示，病理完全缓解是唯一与疾病特异性生存率显著相关的变量（p<0.045）。
非局部浸润性尿路上皮癌的吉西他滨和卡铂诱导化疗可达到临床和病理缓解率及生存结果与顺铂为基础的联合化疗方案相当。我们的数据表明，卡铂为基础的方案可被视为术前不适合顺铂的患者的合理替代方案。
